Provider Demographics
NPI:1063494193
Name:HARRISON, TERRY OLEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:OLEAN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4579
Mailing Address - Country:US
Mailing Address - Phone:731-642-0025
Mailing Address - Fax:731-644-0899
Practice Address - Street 1:305 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4579
Practice Address - Country:US
Practice Address - Phone:731-642-0025
Practice Address - Fax:731-644-0899
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000011365208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3166718Medicaid
TN010063814OtherRAILROAD MEDICARE
TNBO3189Medicare UPIN
TN3166718Medicaid